The role of a healthy diet is well recognised and people are constantly looking for dietary strategies that can help them meet their nutritional targets. Yet we all want to like what we eat and one fairly universally popular taste is sweetness.
However, in times when the obesity epidemic is a global reality, the need to reduce excess calorie and sugar intake is highlighted by scientific organisations around the world. In light of this, health policymakers are encouraging the food industry to create products with a lower sugar content to help address the problem. In this context, low-calorie sweeteners are of interest to consumers as well as the food industry, as they can provide the sweet taste without the associated calories.
Despite this, the media headlines tend to ignore the research into the benefits of low-calorie sweeteners, preferring instead to focus on isolated research, or studies with overreaching conclusions, leading to consumer confusion. The aim of this article is to provide evidence-based information on how low-calorie sweeteners can be used and to debunk some of the myths surrounding their benefits.
The basics
Before the scientific evidence is addressed, it’s worth taking a quick look into what low-calorie sweeteners are and how they are used. These sweet-tasting ingredients have few or no calories, and provide a simple way of reducing the amount of sugar and calories in diets without affecting how foods and drinks are enjoyed.
Also frequently referred to as sugar substitutes, non-nutritive sweeteners, intense or high-potency sweeteners, they are typically hundreds of times sweeter than sugar by weight. This means that only very small quantities are needed to achieve the requisite effect in foodstuffs.
All approved low-calorie sweeteners are safe. In fact, they are among the most tested ingredients available today. Any additive designed for use on the market must undergo a thorough safety assessment by a competent authority. These regulatory authorities include for example the Joint Food and Agriculture Organisation (FAO); World Health Organization (WHO); Expert Committee on Food Additives (JECFA); the US Food and Drug Administration (FDA); and the European Food Safety Authority (EFSA), all of which have consistently confirmed the safety of low-calorie sweeteners.
It is widely, and correctly, held that low-calorie sweeteners can be an ally in weight loss. Given that they contribute no – or virtually no – calories to the food and drinks they are added to, it follows that swapping sugar for them results in fewer calories being consumed – all other things remaining equal – and therefore can help in weight loss.
Many randomised controlled trials (RCTs), which are considered the gold standard for clinical research, show that low-calorie sweeteners can help to reduce overall calorie intake, and be a beneficial tool for weight loss and management strategies, when used in place of sugar, and as part of a balanced diet and healthy lifestyle.
Weight of evidence
A 2016 review that analysed evidence from 90 animal studies, 12 prospective cohort studies, 129 comparisons in short-term experimental studies and nine long-term RCTs, concluded that, “A considerable weight of evidence [is] in favour of consumption of low-calorie sweeteners in place of sugar as [being] helpful in reducing relative energy intake and body weight, with no evidence from the many acute and sustained intervention studies in humans that low-calorie sweeteners increase energy intake.”
Low-calorie sweeteners neither promote nor suppress appetite, and there is no evidence supporting the notion that they might encourage a ‘sweet tooth’. On the contrary, recent intervention studies in children and adults have confirmed that using low-calorie sweeteners tends to reduce, rather than increase, the intake of sugar-containing foods, and helps with, rather than impairs, weight loss.
The periodic negative stories that link low-calorie sweeteners with obesity are usually rooted in the outcomes of ‘observational studies’. What is important to know, however – and what is commonly ignored in the headlines – is that, by definition, observational studies cannot prove cause and effect. Rather, they show associations. Some researchers have looked at dietary survey data and found a correlation between people who reported frequently consuming low-calorie sweeteners and the condition of obesity. However, this does not prove anything, except that a correlation was found. Indeed, a study by Drewnowski and Rehm showed that obese people often consumed low-calorie sweeteners as part of a weight-management strategy.
Glucose control in diabetes
Research shows that even high intakes of low-calorie sweeteners, including for long periods of time, will not adversely affect glucose regulation, either in healthy individuals or in people with diabetes. Therefore, when used instead of sugar, low-calorie sweeteners can be a very helpful tool to people with diabetes, for whom glycaemic control is fundamental.
The beneficial effect of low-calorie sweeteners in post-prandial glucose is also an authorised health claim in the EU Register of nutrition and health claims, further to the scientific opinion by EFSA, which concluded in 2011 that, “Consumption of foods containing low-calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods.”
Overall, medical and scientific organisations recognise that for diabetics, low-calorie sweeteners used alone or in foods and beverages remained an option, and, when used appropriately, could help with glucose control. This was the conclusion of a common position statement by the American Heart Association (AHA) and the American Diabetes Association (ADA) in 2012.
ADA added in 2017 that, “For people who are accustomed to sugar-sweetened products, non-nutritive sweeteners have the potential to reduce overall calorie and carbohydrate intake.”
From a diabetic perspective, low-calorie sweeteners can be considered a helpful tool for managing sweet cravings and offer broader food choices.
It is important to note, though, that foods containing low-calorie sweeteners may affect glycaemia due to other potential ingredients in the product in question, such as carbohydrates. Anyone with diabetes should check food labels to review the full ingredients list of all products.
Bottom line for food reformulation?
Sugar reduction has emerged as a key nutrition policy issue in the effort to halt the obesity epidemic, with scientific and medical organisations around the world acknowledging that increased sugar intake can be contributing to excess weight gain.
There is now a wide range of approved and great-tasting low-calorie sweeteners, with unique taste profiles and characteristics, that can be used alone or in blends, to replace sugar in foods and beverages and to provide a wider choice of sweet-tasting products that contain fewer calories.
The recent innovations and advances in recipe development from manufacturers and the food industry have turned low-calorie sweeteners into a key tool in food reformulation. For consumers, this can mean significant calorie saving from sugar, especially in light of recent WHO recommendations to reduce the intake of sugars in the diet to less than 10% of our daily energy intake.
The role of low-calorie sweeteners in food reformulation and sugar reduction is also recognised in a report published by Public Health England (PHE) in 2017 in which the use of low-calorie sweeteners is endorsed: “Replacing foods and drinks sweetened with sugar with those containing no or low-calorie sweeteners could be useful in helping people to manage their weight, as they reduce the calorie content of foods and drinks while maintaining a sweet taste.”
Beyond the headlines
Research shows that approved low-calorie sweeteners are safe and useful tools that can help reduce calorie and sugar intake. While they are neither a cure-all nor a magic bullet, the scientific facts supporting their use are clear:
- Evidence suggests that, when used in place of sugar, low-calorie sweeteners can help people reduce overall energy intake, which in turn, can help with weight loss.
- Low-calorie sweeteners can also be a significant aid to people with diabetes, as they do not affect blood glucose control and can help make it easier to meet carbohydrate intake goals.
- With dental caries being among the most widespread noncommunicable diseases, low-calorie sweeteners can play an important role in oral health, as they are non-fermentable, and therefore are non-cariogenic and tooth-friendly.
- Research suggests that people who use low-calorie sweetened products also tend to follow healthier diets and lifestyles.
Facts, rather than myths, are what will help sugar-reduction policies. The public deserves to understand how safe and beneficial low-calorie sweeteners are.
This is especially true when obesity and related chronic diseases are on the rise, and when all available and sound dietary strategies for calorie reduction, weight management and glucose control are important.
